Learning from women with psychosis

The article describes psychoanalytic reflections in the work of a consultant psychiatrist responsible for a recently developed female intensive care unit. The manifestations of aggression were observed to be different from that of male patients. The behavioural manifestation of aggression by women was linked to the themes of secrets, and of hidden aggression, which are described in the analytic literature as feminine characteristics. The relationships between women as sibling inpatients and with female staff may explain some of the difficulties in managing aggression. Hidden aggression in the dyad of female-to-female transferences and countertransference may contribute to problems in all female inpatient settings. Bringing together the themes of psychosis and of women from a psychoanalytic perspective, the author suggests that the care pathway leading to transfer to the intensive care unit may exacerbate psychotic symptoms in acute states, due to specific vulnerabilities of women. The provision of specialized inpatient services for women may be more therapeutic if female development and the nature of their relationships were better understood.